Skull-base reconstruction

A combined craniofacial approach to lesions of the skull base has allowed for treatment of what was previously unresectable disease. In the past, patients were often treated palliatively. Currently, combinations of surgery, radiation, and chemotherapy are securing high rates of local control. The cornerstone of treatment of many skull-base lesions has become a combined neurosurgical/head and neck approach. Advancements in preoperative radiographic imaging along with improved surgical techniques have allowed larger composite resections. The aim of reconstruction is to obtain adequate functional and cosmetic results while minimizing postoperative complications. Meticulous reconstruction of the skull base is required to avoid the potentially lethal complications of cerebrospinal fluid rhinorrhea, meningitis, and brain herniation. As the surgical defects have become larger and more complex, so has the need to obliterate these defects in order to improve quality of life. Depending on the size of the cavity to be reconstructed, techniques and options vary from split-thickness skin grafts and pericranial flaps to free rectus abdominus flaps.